Utilisation of outpatient physiotherapy in patients following total knee arthroplasty – a systematic review

Objective Data on the utilisation of outpatient physiotherapy (PT) in patients following total knee arthroplasty (TKA) are scarce, and available studies have not been systematically synthesised. This study aims to summarise the existing literature on outpatient PT following TKA as well as to identify factors associated with its use. Methods A systematic literature search in MEDLINE (via PubMed), CINAHL, Scopus and PEDro was conducted in July 2020 without language restrictions. Two authors independently selected studies, extracted data and assessed study quality. The primary outcome was the proportion being treated with at least one session of outpatient PT (land- or water-based treatments supervised/provided by a qualified physiotherapist) during any defined period within 12 months following TKA. Furthermore, predictors for the use of PT were assessed. Studies including only revision surgeries or bilateral TKA were excluded. Results After screening 1934 titles/abstracts and 56 full text articles, 5 studies were included. Proportions of PT utilisation ranged from 16.7 to 84.5%. There were large variations in the time periods after hospital discharge (4 weeks to 12 months) and in the reporting of PT definitions. Female sex was associated with higher PT utilisation, and compared to patients after total hip arthroplasty, utilisation was higher among those following TKA. Conclusion Despite using a broad search strategy, we found only 5 studies assessing the utilisation of PT after hospital discharge in patients with TKA. These studies showed large heterogeneity in PT utilisation, assessed time periods and PT definitions. Clearly, more studies from different countries with uniform PT definitions are needed to address this relevant public health question.

The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS): application and psychometric analysis in a post-COVID-19 syndrome cohort

Background: As our understanding of the nature and prevalence of Post-COVID-19 syndrome (PCS) is increasing, a measure of the impact of COVID-19 could provide valuable insights into patients' perceptions in clinical trials and epidemiological studies, as well as routine clinical practice. Objective: To evaluate the clinical usefulness and psychometric properties of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) in patients with PCS. Design: A prospective, observational study of 187 consecutive patients attending a post-COVID-19 rehabilitation clinic. The C19-YRS was used to record patients' symptoms, functioning and disability. A global health question was used to measure the overall impact of PCS on health. Classical psychometric methods (data quality, scaling assumptions, targeting, reliability and validity) were used to assess the C19-YRS. Results: For the overall scale, missing data were low, scaling and targeting assumptions were satisfied, and internal consistency was high (Cronbach's alpha = 0.891). Relationships between perception of health and patients' reports of symptoms, functioning and disability demonstrated good concordance. Conclusions: This is the first study to examine the psychometric properties of an outcome measure in patients with PCS. In this sample of patients, the C19-YRS was clinically useful and satisfied standard psychometric criteria, providing preliminary evidence of its suitability as a measure of PCS.

Hubungan antara Kepuasan Kerja dan Kesihatan Psikologi dalam kalangan Pekerja Wanita di Kementerian Belia dan Sukan, Putrajaya

Kajian ini dijalankan bertujuan untuk mengkaji hubungan antara kepuasan kerja dan kesihatan psikologi dalam kalangan pekerja wanita di Kementerian Belia dan Sukan (KBS), Putrajaya. Borang soal selidik Job Satisfaction Survey (Spector, P. E. 1997) diguna pakai untuk mengukur lima faktor kepuasan kerja, iaitu gaji, penyeliaan, suasana pekerjaan, rakan sekerja dan kenaikan pangkat. Manakala General Health Question (Goldberg and Hillier, 1979) diguna pakai untuk mengukur tiga dimensi kesihatan psikologi, iaitu kegelisahan dan insomnia, disfungsi sosial dan kemurungan. Seramai 175 pekerja wanita di KBS terlibat dalam kajian ini. Dapatan kajian menunjukkan terdapat hubungan yang negatif antara kepuasan kerja dan kesihatan psikologi. Hasil penyelidikan ini dapat disimpulkan bahawa kepuasan kerja dan kesihatan psikologi adalah penyebab penting kepada kesihatan pekerja. Apabila pekerja berasa gembira dengan kerja mereka, mereka menjadi lebih produktif dan cenderung untuk menjadi lebih sihat. Apabila pekerja merasa tertekan dengan bebanan kerja, dan secara tidak langsung boleh mempengaruhi kesihatan mereka. Cadangan kajian adalah agar lebih banyak kajian yang dibuat dengan lebih luas dan terbuka dan pemboleh ubah lain yang mempunyai kesan terhadap kepuasan kerja dan kesihatan psikologi pekerja juga diambil kira. Sebagai contoh, hubungan antara kepuasan kerja dan kesihatan psikologi di kalangan pekerja wanita perlu dibandingkan pada kedua-dua sektor iaitu sektor kerajaan dan swasta untuk melihat perbezaan faktor kepuasan kerja dan juga faktor kesihatan psikologi dalam kalangan pekerja wanita di Malaysia yang mungkin dipengaruhi oleh faktor lain.

Can a brief multimedia intervention facilitate breast cancer patients’ communication about sexual health? Findings from a randomized controlled trial.

e24179 Background: Many women with breast cancer (BC) lack the confidence to discuss sexual health with their clinicians. We evaluated, in a randomized controlled trial, a brief multimedia intervention designed to facilitate BC patients’ communication about sexual health. Methods: We randomly assigned BC patients to either a multimedia sexual/menopausal health communication skills intervention [ Starting the Conversation (STC), including a video, workbook, and pamphlet with local and web-based resources] or a control [resource guide only]. About 1-2 weeks after patients received materials, we audio recorded a clinic encounter with their BC provider, and subsequently coded the dialogue for patients raising the topic of sexual health or asking > 1 sexual health question. Self-report surveys administered at baseline, post-intervention, and 2-month follow-up assessed patients’ self-efficacy for discussing sexual health with their BC providers, sexual function, anxiety and depression, and quality of life. T-tests or mixed-effects logistic regression compared study arms; analyses of communication outcomes (patient raising the topic or asking a question during clinic encounter) were clustered by providers. Results: Study participants were 144 BC outpatients (82% acceptance rate; mean age = 56; 67% white; 15% metastatic; 31% active treatment). Women in the STC arm versus the control arm were more likely to raise the topic of sexual health [OR = 2.48 (1.11, 5.55), p= .03] and more likely to ask a sexual health question [OR = 2.93 (1.04, 8.26), p= .04]. Specifically, 51% of women in the STC arm raised the topic of sexual health versus 30% in the control arm and 40% of women in the STC arm asked a sexual health question versus 19% in the control arm. At 2-month follow-up, women in the STC arm showed greater improvements in self-efficacy ( p= .03) and anxiety, t(139) = 2.0, p= .04) compared to the control arm. Conclusions: STC, a brief multimedia intervention, was effective in facilitating BC patients’ communication about sexual health during routine clinic encounters and significantly reduced patients’ anxiety, possibly due to greater patient confidence in expressing their medical needs. Future studies should use longer-term follow-up and examine how sexual health communication can translate to improved patient sexual outcomes. Clinical trial information: NCT03624972 .

Patient Questions and Physician Responses in a Chinese Health Q&A Website: Content Analysis

Background Since the turn of this century, the internet has become an invaluable resource for people seeking health information and answers to health-related queries. Health question and answer websites have grown in popularity in recent years as a means for patients to obtain health information from medical professionals. For patients suffering from chronic illnesses, it is vital that health care providers become better acquainted with patients’ information needs and learn how they express them in text format. Objective The aims of this study were to: (1) explore whether patients can accurately and adequately express their information needs on health question and answer websites, (2) identify what types of problems are of most concern to those suffering from chronic illnesses, and (3) determine the relationship between question characteristics and the number of answers received. Methods Questions were collected from a leading Chinese health question and answer website called “All questions will be answered” in January 2018. We focused on questions relating to diabetes and hepatitis, including those that were free and those that were financially rewarded. Content analysis was completed on a total of 7068 (diabetes) and 6685 (hepatitis) textual questions. Correlations between the characteristics of questions (number of words per question, value of reward) and the number of answers received were evaluated using linear regression analysis. Results The majority of patients are able to accurately express their problem in text format, while some patients may require minor social support. The questions posted were related to three main topics: (1) prevention and examination, (2) diagnosis, and (3) treatment. Patients with diabetes were most concerned with the treatment received, whereas patients with hepatitis focused on the diagnosis results. The number of words per question and the value of the reward were negatively correlated with the number of answers. The number of words per question and the value of the reward were negatively correlated with the number of answers. Conclusions This study provides valuable insights into the ability of patients suffering from chronic illnesses to make an understandable request on health question and answer websites. Health topics relating to diabetes and hepatitis were classified to address the health information needs of chronically ill patients. Furthermore, identification of the factors affecting the number of answers received per question can help users of these websites to better frame their questions to obtain more valuable answers.